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[Binswanger's type encephalopathy without alopecia and lumbago in young hypotensive patients]
1First Department (Neurology) of Internal Medicine, Kurume University School of Medicine.
Insights
This study identifies a distinct form of Binswanger's type encephalopathy in younger adults characterized by persistent hypotension, not hypertension. These findings suggest hypotension may play a role in this neurological disorder.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroscience
Background:
- Binswanger's type encephalopathy is typically linked to hypertension and arteriosclerosis, causing dementia and subcortical ischemic lesions.
- Familial normotensive juvenile cases with alopecia and lumbago have been previously reported, suggesting potential new syndromes.
- Understanding variations in Binswanger's type encephalopathy is crucial for accurate diagnosis and management.
Observation:
- Three cases of young-onset Binswanger's type encephalopathy (under 40) with persistent hypotension were observed.
- Patients presented with ischemic strokes and/or transient ischemic attacks, with white matter damage evident on imaging.
- Unlike previously described normotensive cases, these patients exhibited chronic hypotension without alopecia or lumbago.
Findings:
- Persistent hypotension was a key characteristic in these young-onset Binswanger's type encephalopathy cases.
- Cerebrovascular disease risk factors were absent, yet imaging revealed multiple lacunes and white matter damage, indicating a vascular origin.
- The findings differentiate these cases from the classic hypertensive form and previously reported normotensive variants.
Implications:
- Persistent hypotension may be an underrecognized factor in the pathogenesis of certain Binswanger's type encephalopathy cases.
- This study expands the clinical spectrum of Binswanger's type encephalopathy, highlighting hypotension as a potential contributing factor.
- Further research is needed to elucidate the mechanisms linking hypotension to white matter damage in this condition.
Abstract:
Binswanger's type encephalopathy is characterized by progressive dementia and diffuse subcortical ischemic lesions associated with arteriosclerosis. Hypertension is believed to be a major pathogenic factor in causing this encephalopathy but there are some cases of the encephalopathy not suffering from hypertension. In 1985, Yamamura et al. and Fukutake et al. reported familial cases of normotensive juvenile Binswanger's type encephalopathy with alopecia and lumbago, and considered it to be possibly a new clinical syndrome. We reported three cases of relatively young-onset (under the age of 40) Binswanger's type encephalopathy with persistent hypotension. All three patients suffered from neither alopecia nor lumbago. Patient (male aged 40) had repeated episodes of ischemic stroke and had progressive dementia. Patients 2 (male aged 41) and 3 (male aged 34) were not in a state of dementia, but had a history of transient ischemic attacks, and at present are completely symptom-free. Though there were no risk factors for cerebrovascular disease in these cases, the repeated episodes of ischemic stroke and the existence of small multiple lacunes in the basal ganglia on CT and MRI suggest that the white matter damage was principally due to a vascular disorder. In these cases, persistent hypotension was characteristic and might be a factor for the induction and exacerbation of this encephalopathy. These three cases are different from the classic form of Binswanger's type encephalopathy based on hypertension. Normotensive cases have been described before, but our cases do not seem to fall into this category because the blood pressure constantly remained hypotensive.(ABSTRACT TRUNCATED AT 250 WORDS)